title: The community health educator referral liaison (CHERL): a primary care practice role for promoting healthy behaviors.
abstract: BACKGROUND
  Tobacco use, unhealthy diet, physical inactivity, and risky alcohol use are leading causes of preventable death. As there are many barriers that prevent primary care clinicians from effectively assisting patients with these behaviors, connecting patients with health behavior resources may reduce these unhealthy behaviors.
  
  
  METHODS
  A new adjunct role in primary care practice, the community health educator referral liaison (CHERL), was tested in 15 practices in three Michigan communities. All practices were advised how to access this liaison, and nine practices were randomly selected to receive support to develop a systematic referral process. Adult patients needing improvement in at least one of the four unhealthy behaviors were eligible for referral. The CHERL contacted referred patients by telephone; assessed health risks; provided health behavior-change counseling, referral to other resources, or both; and sent patient progress reports to referring clinicians. Data were collected from February 2006 through July 2007.
  
  
  RESULTS
  The CHERLs received 797 referrals over 8 months, a referral rate of 0%-2% per practice. Among referred patients, 55% enrolled, and 61% of those participated in multiple-session telephone counseling; 85% were referred to additional resources. Among patients enrolling, improvements (p<0.001) were reported at 6 months for BMI, dietary patterns, alcohol use, tobacco use, health status, and days of limited activity in the past month.
  
  
  CONCLUSIONS
  The results of this study suggest that through relationships with practices, patients, and community resources, these liaisons successfully facilitated patients' behavior change. The CHERL role may fill a gap in promoting healthy behaviors in primary care practices and merits further exploration.
authors.affiliation: Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan 48824, USA. jodi.holtrop@hc.msu.edu
authors.forename: Jodi Summers
authors.initials: JS
authors.lastname: Holtrop
authors.forename: Steven A
authors.initials: SA
authors.lastname: Dosh
authors.forename: Trissa
authors.initials: T
authors.lastname: Torres
authors.forename: Yeow Meng
authors.initials: YM
authors.lastname: Thum
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology; D015992:Body Mass Index; D003625:Data Collection; D037001:Directive Counseling / Q000379:methods; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006304:Health Status; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D011897:Random Allocation; D012017:Referral and Consultation / Q000458:organization & administration*; D012907:Smoking / Q000523:psychology; D000074606:Smoking Prevention; D013689:Telephone